Shire Jobs

• Serve as plan liaison for physicians/physician groups in a specified geographical area. Will be the main point of contact for all plan related issues including marketing, enrollment, contracting, billing and reimbursement.

• Responsible for the resolution of all issues, including those identified by the provider, and those identified internally that have an impact on the physician. Coordinates with all Healthfirst staff to assist as appropriate, including creating project plans, issue logs, conference calls, etc.

• Responsible for the provider recruitment process. Identify gaps, complete paperwork, etc.

• Schedule frequent and regular face-to-face contact with the practice locations to identify any issues and ensure plan visibility.

• Keep abreast of competitor activity, including new reimbursement and marketing strategies. Negotiate favorable/competitive rates with providers based on market trends.

• Conduct new provider orientation and identify opportunities for education on both clinical and administrative topics. Includes experts in the field of education as needed from in-house staff.

• Responsible for monitoring and reporting on providers' clinical quality & financial performance, working with their manager and other internal departments to create strategic improvement plans.

• Working under light supervision, maneuvers multiple tasks independently with a fast paced proactive vs. reactive approach to changing priorities while meeting departmental objectives. Attention to managing many details and remaining focused in an environment with distractions.

• Contribute creative solutions and ownership of daily assignments for seamless communication and systematic completion of routine and special projects. Follow protocols and use common sense to escalate situations to management appropriately.

• Handle other duties as assigned with the occasional need to work weekends, overtime and/or travel throughout the tristate area. Engage in mastering the Division's impact on Healthfirst, its Members, and Providers

Minimum Qualifications:

• Medicare and/or Medicaid managed care experience

• Excellent oral and written communication skills (Letter writing, Memo, and Email)

• Must speak, read and write at least one of the following languages (Urdu, Bengali, Hindi, Punjabi, Nepali )

Preferred Qualifications:

• Bachelors Degree from an accredited institution

• Active driver license and access to a vehicle

• Provider office operations experience

• Ability to understand Provider claims reimbursement

• Contract negotiation experience

• Bilingual fluency (reading, writing, speaking) Chinese or Spanish and English

• Exposure to multiple functions especially finance, business intelligence

• Experience with Microsoft office such as Excel, Outlook, and/or electronic archiving

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.